Healthcare Provider Details

I. General information

NPI: 1679034466
Provider Name (Legal Business Name): RICHARD LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 05/07/2024
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S STE 400
ORANGE CA
92868-3201
US

IV. Provider business mailing address

PO BOX 15090
ANAHEIM CA
92803-5090
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5691
  • Fax:
Mailing address:
  • Phone: 714-772-8282
  • Fax: 714-772-6493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA178607
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA178607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: